First surgical procedure for live kidney donation

A team of Filipino doctors has successfully performed the first surgical procedure in the Philippines for live kidney donation that is safe, minimally invasive and relatively pain-free.

The novel surgical procedure is called Retroperitoneoscopic Donor Nephrectomy (RPLDN)and was performed at the Providence Hospital in Quezon City by Dr. Juvido P. Agatep, Jr., proponent of Retroperitoneoscopic Surgery in the Philippines. He was assisted by Drs. Christopher Perez, Jayson Dequina, and Carlo Andutan.

The surgical approach to live kidney donation has recently undergone significant changes since the introduction of laparoscopic nephrectomy. Kidney donation is a surgical procedure that is less complicated compared with diseased kidney, yet the surgical challenge is to operate on healthy donor patients without any benefit gained from the procedure. Minimizing risks associated with donor morbidity and mortality is therefore of paramount importance and the safety of the kidney donor is an absolute priority.

Minimally invasive surgery is a procedure that uses small (less than 1 cm) incisions to retrieve an organ with the aid of a camera and a monitor. Several studies comparing conventional open live donor nephrectomy and minimally invasive donor nephrectomy resulted in less post‐operative pain, a shorter hospital stay, a faster return to work and greater number of patients donating their kidneys in favor of laparoscopic procedure.

However, in most cases of laparoscopic live donor nephrectomy, the transperitoneal approach is a procedure that enters the abdominal cavity and involves the mobilization of the bowels and other intraperitoneal organs. This approach always carries a potential risk of bowel injury and of late onset bowel obstruction due to adhesion of the intestines, causing a higher risk of vascular injury.

On the other hand, retroperitoneoscopic live donor nephrectomy is another option of minimally invasive procedure that does not enter the abdominal cavity. Instead it enters the posterior of the patients- “back door style” without involvement of the intraperitoneal organs. Therefore, it does not cause any bowel complications such as bowel injury, prolonged paralysis of the intestines or bowel obstruction due to adhesions, or risk of vascular, spleen and liver injury. This highly preferred procedure is already being employed in some parts of  Europe, Japan and Asian countries.

Dr. Juvido Agatep, Jr. led the team of medical specialists who carried out the first Retroperitoneoscopic Surgery in the Philippines.  He is head of the urology section of Providence Hospital and head of the minimally invasive section of East Avenue Medical Center.

Dr. Agatep took up Retroperitoneoscopic and Laparoscopic urology and tumor surgery at the University of Heidelberg-Klinikum in Heilbronn, Germany, and is presently on a two months fellowship training in Endourology-Ultrasound Guided PCNL at the Beijing Tsinghua Changgung Hospital in Beijing, China.

Dr. Agatep underwent fellowship training in renal transplantation surgery and minimally invasive donor nephrectomy at the Erasmus Medical Center in Rotterdam, Netherlands, as well as clinical observership training in prostate cancer, urologic oncology and ultrasound fusion guided prostate biopsy at the Ronald Reagan UCLA Medical Center in Los Angeles, California.

Other members of the team that performed the breakthrough RPLDN procedure include transplant surgeons Drs. Erwin L. Jardinico and Charlton S. Sibal; anesthesiologists Drs. Lorlyn A. Agatep, Rechelle Bulandoz, Theresa Valencerina and Yoya Alabanza; and nephrologist Dr. Helen Ocdol.

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